Under the Knife: MLB Injury Analysis on Ventura, Darvish, Arenado and More

Josh Beckett threw a no-hitter, and Hyun-Jin Ryu nearly topped it with a perfect game. That's downright impressive, but there's more behind it than just two lucky performances. This is a microcosm of the game right now: sports medicine, international signings and pitching dominance.

If there was a stat as easily understood as home runs, we'd be looking at a mid-90s "steroid era" for the pitchers. When there were a few young pitchers coming up in the game a few years ago, I wondered if we were headed for a cyclic change from power hitters to power pitchers. It came and then some. Strikeouts are popping up, but pitchers don't get enough outings to approach the heights of the 1970s. Randy Johnson levels? Maybe.

The top five pitchers in strikeouts are averaging 83 K's over 11 starts each. That's 7.5 per start. The difference comes in innings pitched, where there's a 15-inning difference. It's no surprise that Stephen Strasburg is doing more in fewer innings, but again, why is he being held back by pitch counts and innings limits when he's showing dominance and no visible sign of fatigue?

Johnson was getting 35 starts when he was striking out 372 batters in a season, but he was also going deeper into games. He's a freak and shouldn't be a pure comparison, but the change in opportunities shows why strikeout numbers aren't jumping to odd proportions and making this a more stark case for the casual fan.

For Beckett, it's a triumphant return. His thoracic outlet syndrome is a memory, and his shoulder problems are controlled. He's not an ace again, but for one day, he was as good as it gets. The Dodgers were hoping that Beckett would hold down the back end of the rotation at best. Instead, he's given them stability and options. With a couple of guys ready to fill in, the Dodgers suddenly have depth.

Credit that to the Dodgers medical staff and Beckett's off-field team. There's a long way to go with shoulders, but Beckett is showing that there's progress on that front. For now, there are plenty of other injuries around MLB, so let's get to those...

Orlin Wagner/Associated Press

Yordano Ventura

The Royals dodged a bullet, but they didn't unload the gun. Yordano Ventura came out of the MRI tube without significant damage to his elbow, but the Royals haven't said what the problem is. They simply may not know, but whatever it was that caused the pain and loss of velocity will need to be fixed.

Kansas City says Ventura will miss only one start with the elbow issue, but to stay on track to do so, he'll need to make his side work in five days. Watch for that and see whether or not the Royals figure out the cause of the injury. If not, it's going to be worrisome each and every time his electric stuff gets on the mound. I wrote in more detail about Ventura's injury here.

Kathy Willens/Associated Press

Noah Syndergaard

It was apparently a good MRI day around baseball. The Mets may have flown prospect Noah Syndergaard across the country for an MRI and a check with their team physician, but this was never a major concern. UCL tears are relatively easy to diagnose manually with things like the milking test, but there are other reasons to bring a top prospect into the home office.

There are consistency-of-care situations; the Mets will want David Altchek to know Syndergaard's elbow well (but not too well!). Altchek is one of the top elbow surgeons, so why wouldn't the Mets want to take advantage of that resource, especially in a situation as potentially valuable as this one?

The team will likely be very conservative with Syndergaard's return despite the positive outcome. There's no real reason to rush, though they are still hoping that Syndergaard can at least come up for September.

Patrick Semansky/Associated Press

Matt Wieters

Matt Wieters is making some progress with his elbow. It's not much and not enough to say that he'll be able to come back or avoid surgery, but enough to wonder just how much is the result of what is now being called "biologics." These injections, the common platelet-rich plasma (PRP) or newer stem-cell injections like what CC Sabathia had in his knee, are poorly understood but widely used.

If Wieters can avoid Tommy John surgery through rehab and biologics, it's a win for him and the team. We should know more in a few weeks as he starts gearing up to swing a bat. For more on Wieters and the biologic therapy the Orioles are gambling on, click here.

Chris Szagola/Associated Press

Cliff Lee

It's not just the young pitchers who have elbow problems. Cliff Lee is anything but young, and if you look at his history, you won't find much in the way of arm-injury red flags. There's little or no history. He's very durable and has shown no recovery issues. He wasn't overworked at a young age.

Still, he's human and a pitcher, so a flexor-mass issue isn't unheard of. The question now is how long he'll be out. The Phillies tend to be pretty conservative, as they showed earlier this year with Cole Hamels.

Lee's return date is up in the air, but that's not a bad thing.

The worry now is that stamina will be an issue if he's shut down longer than a couple starts, but I believe that's a bit overblown. If the Phillies can't figure out how to use Lee for 50 pitches with a shadow/tandem, they don't deserve to win.

Chris Schneider/Associated Press

Nolan Arenado

Mallet finger trumps hitting streak, unfortunately. The talented young Colorado Rockies third baseman will shift from a star-in-the-making run to the disabled list after a preventable injury. Arenado was injured on a slide, something that could have been prevented by better sliding gloves, going in feet first or having a change to the base that has been suggested to baseball for several years.

Arenado will miss about six weeks if he can avoid surgery, eight if it's needed in order to correct the fracture and associated tendon issues. As with most finger or thumb injuries, it's grip strength and bat control that will be the toughest part of Arenado's rehab. If he can get healthy on schedule, he's the perfect secondary bat to the middle of the Rockies order. For more info on Arenado's finger, click here.

Quick Cuts

Gene J. Puskar/Associated Press

Yu Darvish

Unremarkable? That's a positive for Yu Darvish coming off a scratched start. Darvish woke up with a stiff neck, the same kind of pain that cost him time at the end of spring training. An MRI showed nothing to speak of, which is good, but this is a recurrent problem that could be back again later.

The Texas Rangers have certainly had a hard time with spines over the last few days, losing Matt Harrison and Prince Fielder for the seasons with severe injuries. There's no clear pattern to suggest this is anything but a fluke, but with so many issues besides these three spinal cases, it's hard to see this as anything more than the latest arrow aimed at the Rangers from an angry fate.

Mark Teixeira

Mark Teixeira had been doing well since his early-season DL stint due to his surgically repaired wrist. The inflammation he's experiencing is normal, but it's problematic. The Yankees medical staff will have to figure out how to minimize this, and it may force another DL stint in order to calm things down. Teixeira has shown that his power returned after wrist surgery, but he'll have to show some durability, too.

LM Otero/Associated Press

Carlos Beltran

Carlos Beltran is swinging a bat. Good sign, yes, given the bone spur that shut him down, but there's no throwing just yet. Beltran could be in for a longer stint on the DL, which wouldn't be good for the Yankees given that they don't have a very flexible roster.

The next step for Beltran will be throwing and hitting against live pitching, but there's a ways to go. If Teixeira is out a while, the first base option will be open, but it's not clear if Beltran will be healthy enough to take up that duty.

Josh Hamilton

It was an odd reason for pausing a rehab assignment. Josh Hamilton has been coming back from thumb surgery, and it was a bone bruise that set him back this week.

How that bruise happened is unclear, but the likely culprit is that he's holding the bat differently. He could be squeezing it harder or softer, letting the bat move in his grip. The Angels should know and should be able to pad it for a bit, but it doesn't bode well for his immediate recovery.

Grip strength and bat control are the issues for these kinds of comebacks. He hasn't had enough at-bats in Salt Lake to really tell if he's having these troubles, but pitchers are going to know that he doesn't like getting jammed.

Watch to see how Hamilton reacts to that—remember, Albert Pujols also reacts strongly to inside pitches—and if he's able to make contact at his normal rate.

Kathy Willens/Associated Press

Jeremy Hellickson

When the Rays lost Matt Moore, the concept was that the team had enough pitching depth to get by. The problem is, it hasn't worked out that way, but not because of the depth. Jeremy Hellickson is in the final stages of his rehab, likely to start a rehab assignment after passing a simulated game this week. He could be back after three or four starts—the Rays are conservative with their rehab plans—but whom he will supplant isn't as clear as expected.

Erik Bedard has a better ERA than the rest of the current Rays rotation, but don't go stat-head on me. The peripherals aren't there for Bedard, so he's the most likely to go, though it's not quite that simple because of roster rules. The Rays want Hellickson back to improve the rotation for the second half, and they hope where he fits will sort itself out while he builds back up.

Chris O'Meara/Associated Press

Chad Billingsley

Another complex situation is about to happen for the Dodgers. Chad Billingsley had a mild setback during his rehab, but it came at a good or bad time, depending on how you look at it.

Beckett is locked in to the back of the rotation now, just as Billingsley's last PRP injection got him back on track for a return. He's likely to be cleared for a simulated game and then rehab assignment just after, but where he goes after that 30 days is an open question.

It's a good problem to have, to be sure, but it will be hard to trade any of the guys at the bottom due to injury history. Instead, they'll have to mix and match, perhaps going to a de facto six-man rotation with an odd skip built in and freer usage of them as relievers when available, but is this something I expect Don Mattingly to handle?

This will likely end up a problem solved by injury, but "too much pitching" isn't really ever a bad thing.

Hanley Ramirez

The Dodgers have had a tough time getting Hanley Ramirez back on the field and a harder time keeping him there. He's bounced back and forth with his calf strain, which indicates that he's not comfortable. The Dodgers medical staff isn't the type to rush someone, so this is likely a movement pattern issue where something Ramirez is doing is aggravating the injury and pushing him backwards.

It's a tough situation, since getting to the root cause is difficult and time consuming. They may have to muddle through as they continue to maintain it and get some distance and healing from the initial injury.

Ramirez wants a big new contract, but it's this kind of low-grade injury that he has a tougher time with than the big ones. He needs to prove this kind of thing is an exception rather than the start of a declining phase marked by injuries.

And I cannot lie.Stephen Dunn/Getty Images

Mike Napoli

It's been a rough couple weeks for Mike Napoli. He had the flu, a bad hamstring, a calf strain and then capped it off with a dislocated finger that finally pushed him to the DL.

Napoli's hip, the big worry that the Red Sox had with him, is fine. Napoli will rest and recharge, with the hope that he re-energizes his bat by getting healthy. Napoli is streaky, but to be streaky, a hitter has to be healthy. Given his injury history, an aging Napoli might decline rapidly with exactly this kind of scattershot problem building up to tear him down.

STEVE NESIUS/Associated Press

I'm excited about joining MLB Network more often in the future, working with them as their "Injury Insider." I've loved my spots over there and hope I get the chance to tell the story of the doctors and athletic trainers around baseball to even more people. I hope you'll tune in, so follow me on Twitter to get the heads-up on those and other TV and radio hits.